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Comparative efficacy of sofosbuvir-ribavirin versus sofosbuvir-daclatasvir for treatment of chronic hepatitis C in an area with limited NS5A inhibitor availability

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Abstract

Introduction

Sofosbuvir (SOF) and daclatasvir (DCV) regimens are recommended for all genotypes of hepatitis C virus (HCV) infection. However, DCV accessibility is still low in several low– and middle-income countries. Ribavirin (RBV) is more affordable and has been known for chronic HCV treatment along with SOF or interferon. The aim of this study was to assess the efficacy of SOF + RBV and SOF + DCV regimens for treatment of chronic HCV in Indonesia.

Methods

We conducted a retrospective study among patients with chronic HCV who were treated with SOF. Data on SOV + RBV were collected from 2015 to 2016, while those on SOF + DCV were collected from 2016 to 2017. The baseline characteristics were recorded from the medical record unit in Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. The primary outcome was the achievement of sustained virological response at 12 weeks (SVR12).

Results

Of 309 patients, 64.4% (199/309) had genotype 1 infections, 29.8% (92/309) had cirrhosis, and 4.9% (15/309) had co-infection with human immunodeficiency virus (HIV). At the end of treatment (EOT), 99.3% (136/137) patients in the SOF + RBV group and 99.4% (164/165) in SOF + DCV group had no detectable viral load. The criterion for SVR12 was met in 90.8% (109/120) patients in SOF + RBV regimen and 98.2% (108/110) in SOF + DCV regimen. Among patients with cirrhosis, 84.4% (38/45) patients and 100% (27/27) achieved SVR12 in the SOF + RBV and SOF + DCV groups, respectively.

Conclusion

SOF + DCV regimen had higher SVR rates compared to SOF + RBV regimen (p = 0.034). However, both the regimens showed an impressive outcome, with overall SVR12 rates above 90%, irrespective of presence of cirrhosis and HCV genotype. In non-structural protein 5A inhibitor limited setting, SOF + RBV regimen still can be used as treatment for HCV infection, particularly in non-cirrhotic patients.

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Authors and Affiliations

  1. Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jalan Diponegoro Number 71, Central Jakarta, Jakarta, 10430, Indonesia

    Juferdy Kurniawan, Rino Alvani Gani, Irsan Hasan, Andri Sanityoso Sulaiman, Cosmas Rinaldi A. Lesmana, Chynthia Olivia Maurine Jasirwan, Kemal Fariz Kalista, Saut Horas Hatoguan Nababan & Steven Zulkifly

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  1. Juferdy Kurniawan
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  2. Rino Alvani Gani
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  3. Irsan Hasan
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  4. Andri Sanityoso Sulaiman
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  5. Cosmas Rinaldi A. Lesmana
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  8. Saut Horas Hatoguan Nababan
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  9. Steven Zulkifly
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Correspondence to Juferdy Kurniawan.

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JK, RAG, IH, ASS, CRAL, COMJ, KFK, SHHN, and SZ declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Kurniawan, J., Gani, R.A., Hasan, I. et al. Comparative efficacy of sofosbuvir-ribavirin versus sofosbuvir-daclatasvir for treatment of chronic hepatitis C in an area with limited NS5A inhibitor availability. Indian J Gastroenterol 37, 520–525 (2018). https://doi.org/10.1007/s12664-018-0921-2

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  • DOI: https://doi.org/10.1007/s12664-018-0921-2

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